Sr Credentialing Coordinator

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Job ID: 51920
Area of Interest: Clerical
Location: Baltimore, MD US
Hours of Work: M-F
Job Facility: U of M Rehabilitation & Orthopaedic Institute
Employment Type: Full Time
Shift: DAY
What You Will Do:

Senior Credentialing Coordinator Opportunity
Full-time/M-F
CPMSM or CPCS Required


Reporting to Chief Medical Officer/VP Medical Affairs, the Sr. Credentialing Coordinator performs the administrative functions related to medical and resident credentialing. Provides administrative support to related Medical Staff committees. Under general direction, supervises the credentialing process to ensure compliance with hospital policies, regulatory bodies, and TJC.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not to be construed as an exhaustive list of all job duties performed by personnel so classified. 
  1. Oversees the documentation of the credentialing process and maintain accurate files for attendings, residents, fellows, and allied health practitioners, for initial appointments and reappointments. Performs administrative duties and provides support in accordance with established policy and procedures and State, Federal, TJC, and NCQA requirements.
  2. Performs reference checks on medical staff applicants by preparing and sending letters for verification to prior hospital affiliations, medical schools, National Practitioner Data Bank, Board of Physician Quality Assurance, etc.
  3. Collects data directly from practitioners such as curriculum vitaes, copies of state licensure, D.E.A. information, and Insurance information.  Requests information from other internal Hospital departments including Medical Records, Risk Management, and Quality Assurance that aid in the reappointment process.
  4. Performs all aspects of the credentialing process including collecting data directly from practitioners, performing primary source verification and reference checks as required, querying the National Practitioner Data Bank, the Maryland Board of Physicians and other required agencies, and preparing files for presentation to the appropriate approving body for assigned departments.
  5. Maintains the accuracy and integrity of credentialing and clinical privileging database system, including “Find a Doc”.
  6. Tracks credentialing status. Maintains communication with Medical Staff Officers, Clinical Chiefs, and Committee Chairpersons. Notifies VP, Medical Affairs of any specific problems that may arise according to the department procedure.
  7. Maintains accurate automated data files and ensures the complete and accurate maintenance of credentials files in assigned area. Provide automate reports and listings.
  8. Coordinates with the CMO/VP, Medical Affairs in the onboarding process of new attendings, residents, fellows, and allied health professionals.
  9. Represents UM Rehab & Ortho when working with various outside agencies including Maryland licensing boards for verification of physician licensure and obtaining information on individual physicians. Acts as liaison to the Educational Commission for Foreign Medical Graduates regarding physician licensure/visa issues.
  10. Organizes and performs support for the Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) process for all credentialed Um Rehab & Ortho practitioners. Understands the OPPE and FPPE requirements from The Joint Commission and other regulatory agencies, and maintains a system for the timely completion and reporting of these evaluations.
  11. Works closely VP Medical Affairs to develop and implement common priorities and goals for the department to enhance customer service, maximize operational efficiency, ensure high quality healthcare, and support the institutional priorities.
  12. Assists in the ongoing compliance with all appropriate accrediting and regulatory agencies including the facilitation of periodic delegated credentialing audits.
  13. Provides staff support to Medical Staff President and other assigned committees, by preparing meeting agendas, recording meeting minutes if applicable, collecting necessary information, and following up on committee actions.
  14. Maintains current knowledge base of credentialing standards, regulations and contract requirements. Reviews credentialing policies and procedures and recommends appropriate changes to the CMO/VP, Medical Affairs regarding application forms so that UM Rehab & Ortho maintains compliance with Medical Staff Bylaws, changes in State and Federal law, and TJC and NCQA standards.
  15. Works with clinical and corporate departments as appropriate to maximize operational efficiency and service. Functions as a liaison between the Medical Staff Office, members of the Credentials Committee, Department Chairmen and Program Directors.
  16. Establishes and maintains courteous and effective relationships with co-workers and other members of the hospital staff; demonstrates sensitivity and awareness of confidential matters.
  17. Observes established Medical System and departmental policies and procedures, objectives, and quality assurance requirements.


What You Need to Be Successful:

Education:

  • High School Diploma or equivalent (GED) is required.
  • Associate’s degree or higher from an accredited college in business or related field or equivalent experience preferred.

Experience:

  • Must be certified by the National Association of Medical Staff Services (either CMSC or CPCS).
  • Three years in a hospital environment, two years of which involve credentialing.

We are an Equal Opportunity/Affirmative Action employer.  All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. 
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